Healthcare Provider Details
I. General information
NPI: 1861201634
Provider Name (Legal Business Name): GOLDEN STEPS ABA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1000 CROMWELL BRIDGE RD
TOWSON MD
21286-3308
US
IV. Provider business mailing address
560 SYLVAN AVE STE 2048
ENGLEWOOD CLIFFS NJ
07632-3165
US
V. Phone/Fax
- Phone: 410-705-0227
- Fax:
- Phone: 678-894-1116
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
REBECCA
ROSS
Title or Position: CREDENTIALING
Credential:
Phone: 678-894-1116